The Acupuncture Effect on Median Nerve Morphology in Patients with Carpal Tunnel Syndrome: An Ultrasonographic Study

Laser Acupuncture Versus Electroacupuncture for Nonsevere Carpal Tunnel Syndrome: A Randomized Controlled Trial

Background

Electroacupuncture (EA) is commonly employed for carpal tunnel syndrome (CTS), whereas laser acupuncture (LA) seems to offer a safer and more convenient alternative. Nevertheless, transitioning from EA to LA requires evidence. This study aims to compare their clinical efficacy and safety.

Methods

A randomized single-blind controlled trial was conducted on 76 CTS patients, with 38 patients assigned to receive EA (EA group) and 38 assigned to receive LA (LA group). Acupoints selected for both groups included PC4, PC6, PC7, PC8, LI4, LI10, LI11, HT3, HT7, and LU10. The intervention consisted of 20 sessions over 4 weeks. Symptom Severity Scale (SSS) and Functional Status Scale (FSS) scores, patients' satisfaction, and adverse events (AEs) were recorded.

Results

The LA group demonstrated significantly greater reductions in SSS and FSS scores than the EA group, with mean differences (MDs) and 95% confidence interval (95% CI) of -4.29 (-5.40 to -3.18) and -0.73 (-1.24 to -0.24), respectively, after 4 weeks of treatment. Complete symptom, functional recovery, and both were also significantly better in the LA group (relative risks [RR] [95% CI]: 14.00 [1.94 to 101.22], 1.58 [1.24 to 2.02], and 14.00 [1.94 to 101.22], respectively). Overall treatment effectiveness and satisfaction levels were notably higher in the LA group. Six patients experienced AEs in the EA group, whereas no AEs were reported in the LA group.

Conclusions

In this study, the findings indicate that LA may offer a safer and more effective alternative to EA. Further studies with longer follow-up periods and assessment of electrodiagnostic changes after intervention are needed.

A Data Mining Study for Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome

Background

Carpal tunnel syndrome (CTS) is the most prevalent upper limb compressive neuropathy. A considerable number of clinical trials and meta-analyses have provided evidence supporting the effectiveness of acupuncture in treating CTS. Nevertheless, the ideal choice of acupoints remains ambiguous.

Objective

A data mining analysis was conducted with the objective of determining the most effective acupoint combinations and selection for CTS.

Methods

A search was conducted across seven Chinese and English electronic bibliographic databases spanning from their inception to March 2023. Selected were clinical trials that evaluated the efficacy of acupuncture therapy for CTS, with or without randomised controlled methods. Data extraction mainly included acupoint prescriptions. Information such as first author, study design and study setting were also extracted. The principal outcomes comprised the clinical manifestations linked to CTS. Statistical descriptions were generated using Excel 2019. The analysis of association rules was conducted using SPSS Modeler 18.0. Using SPSS Statistics 26.0, exploratory factor analysis and cluster analysis were conducted.

Results

142 trials (including 86 RCTs and 56 non RCTs) were identified, and 193 groups of effective prescriptions involving 68 acupoints were extracted. The most frequently used acupoints were Da-ling (PC7), Nei-guan (PC6), He-gu (LI4), Wai-guan (TE5), and Yang-xi (LI5). The most frequently used meridians were the pericardial meridian and the large intestine meridian. The majority of special acupoints used were Five-shu points and Yuan-source points, with acupoints on the upper limbs being the most frequently used. The core acupoint groups were analyzed and 11 groups of association rules, 8 factors, and 5 effective cluster groups were obtained.

Conclusion

The evidence-based acupoint selection and combinations of acupuncture therapy for carpal tunnel syndrome were provided by the findings of this study.

Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome: A Protocol for Data Mining

Background

Carpal tunnel syndrome (CTS), as the most common compression neuropathy in the upper limb, can lead to upper limb dysfunction in patients. The effectiveness of acupuncture in treating CTS has been validated based on numerous clinical trials and meta-analyses, but questions remain, such as how to select the best acupoints. Our purpose is to conduct the first data mining analysis to identify the most effective acupoint selection and combinations for treating CTS.

Methods

We will search 7 electronic bibliographic databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chongqing VIP Database) from inception to March 2023. Clinical trials assessing the effectiveness of acupuncture therapy on the management of CTS will be selected. Reviews, protocols, animal trials, case reports, systematic reviews, and meta-analyses will be excluded. The primary outcome measure will be clinical result associated with CTS. Descriptive statistics will be performed in Excel 2019. Association rule analysis will be performed in SPSS Modeler 18.0. Exploratory factor analysis and cluster analysis will be performed in SPSS Statistics 26.0.

Results

This study will investigate the most effective acupoint selection and combinations for patients with CTS.

Conclusion

Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint application for patients with CTS, helping clinicians and patients make a more informed decision together.

Acupuncture for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials

Background

The evidence for the effectiveness of acupuncture for patients with carpal tunnel syndrome (CTS) is insufficient. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of acupuncture on CTS through a comprehensive literature search.

Methods

English and Chinese databases were searched from their inceptions until 27 October 2022 to collect randomized controlled trials (RCTs) that investigated the effect of acupuncture on CTS. Two reviewers independently selected studies that met the eligibility criteria, extracted the required data, assessed the risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials (ROB 2), and evaluated the quality of reporting for acupuncture interventions using the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcomes were symptom severity and functional status, while secondary outcomes included pain intensity, responder rate, and electrophysiological parameters. Review Manager software (version 5.4.1) was used for data analysis. The certainty of the evidence was rated with GRADEpro (version 3.6) software.

Results

We included 16 RCTs with a total of 1,025 subjects. The overall risk of bias was rated as low in one RCT, some concerns in 14, and high in one. Compared with night splints, acupuncture alone was more effective in relieving pain, but there were no differences in symptom severity and functional status. Acupuncture alone had no advantage over medicine in improving symptom severity and electrophysiological parameters. As an adjunctive treatment, acupuncture might benefit CTS in terms of symptom severity, functional status, pain intensity, and electrophysiological parameters, and it was superior to medicine in improving the above outcomes. Few acupuncture-related adverse events were reported. The above evidence had a low or very low degree of certainty.

Conclusion

Acupuncture as an adjunctive treatment may be effective for patients with CTS. Additionally, more rigorous studies with objective outcomes are needed to investigate the effect of acupuncture in contrast with sham acupuncture or other active treatments.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=329925, identifier CRD42022329925.

Effect of Manual Acupuncture for Mild-to-Moderate Carpal Tunnel Syndrome: A Systematic Review

Objectives

Despite the low cost and high accessibility of manual acupuncture (MA) treatments for the carpal tunnel syndrome (CTS), this intervention has not been uniformly evaluated in systematic reviews (SR), and no SR has evaluated MA monotherapy for CTS. This review was conducted to summarize the findings and undertake a quality assessment of randomized controlled trials (RCTs) of acupuncture treatment methods for mild-to-moderate CTS to identify clinical evidence for the use of MA in CTS.

Methods

We searched five databases for articles on relevant RCTs that were published until June 2021 without imposing specific restrictions, such as age or sex, on CTS patients. RCTs that evaluated MA were included without any restriction on comparator interventions. Measurement tools for evaluating pain reduction and functional improvement or for evaluating efficacy using electrophysiological indicators were included as outcome measures.

Results

We included seven RCTs, of which three studies reported both post-treatment improvement effects and statistical significance using p-values for all outcomes. Five studies reported statistically significant intergroup differences (p-values for all outcomes) in post-treatment improvement. None of the studies reported severe adverse effects of MA. In all of the RCTs, the reporting rates of the 2c, 2a, and 6a items of STRICTA 2010 were 14%, 29%, and 29%, respectively. PC7 (Daereung) was used to treat CTS in all of the included studies.

Conclusion

MA can be used for CTS treatment without serious adverse effects. PC7 was the most commonly used acupoint. In order to ensure objective and reliable reporting, accurate standardization of acupuncture treatment methods acupoint terms should be undertaken in future RCTs.

Evaluation of Duruöz Hand Index in diagnosis and staging of Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients' demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r: 0.306, p < 0.001) and Boston functional status scale (FSS) (r: 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR: 2.36, p: 0.01), Phalen positivity (OR: 2.22, p: 0.02), Boston symptom severity scale (SSS) scores (OR: 1.76, p: 0.024), increasing age (OR: 1.06, p < 0.001) and increased BMI (OR: 1.07, p: 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.

Efficacy of laser acupuncture for carpal tunnel syndrome: A study protocol for a prospective double-blind randomized controlled trial

INTRODUCTION

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that causes hand discomfort and work disability. Since no satisfactory conventional treatments for mild to moderate CTS exist, we apply complementary alternative medicine (CAM) to this problem. Laser acupuncture (LA), a new, non-invasive therapy which uses low-level-laser therapy (LLLT) in acupuncture could help to manage CTS. However, only one small randomized, double-blind and crossover trial had been conducted, which is not enough to provide an evidence-based assessment of the effects of LA on CTS.

OBJECTIVES

The aim of this study protocol is to investigate the efficacy of LA therapy on patients with mild to moderate CTS through sonography of the median nerve and offer clear parameters of LLLT.

METHODS

This study protocol is a prospective double-blind randomized controlled trial. Forty subjects aged 20 to 80 years old and diagnosed as having mild to moderate CTS will be randomly assigned to the intervention group (real LA, 3-sessions a week for 2 weeks) and control group (sham LA, 3-sessions a week for 2 weeks). All subjects will be asked to wear night splints as the fundamental management approach. The laser parameters will include a wavelength of 808 nm, power output of 300 mW and power density of 300 mW/mm, with ten seconds of treatment for each acupuncture point (PC4, PC6, PC7, PC8, LI4, LI10, LI11, HT3, HT7, and LU10). Sham LA treatment will be applied without any laser power output. The primary outcome will be based the Boston Carpal Tunnel Syndrome Questionnaire and secondary outcomes included a visual analog scale, cross sectional area of median nerve by sonography and electrophysiological test before interventions and after 2, 4, 8, 12 weeks postintervention.

TRIAL REGISTRATION

ClinicalTrials.gov (Identifier: NCT03580265).

Immediate effects of acupuncture on the mechanosensitivity of the median nerve: an exploratory randomised trial

BACKGROUND

Acupuncture appears to reduce the mechanosensitivity of peripheral nerves in animal models; yet, this possibility has not been demonstrated in humans.

OBJECTIVES

The main objective of this exploratory trial was to evaluate the immediate effects of acupuncture on the mechanosensitivity of the median nerve, measured by the elbow extension range-of-motion (EE-ROM) at pain onset and maximum tolerance during the upper limb neurodynamic test 1 (ULNT1). Additional objectives were to test the effects of two different points in ULNT1 responses and critically appraise pre-/post-intervention changes for conducting future research.

METHODS

Thirty-one asymptomatic individuals, randomly assigned to the PC group (n=14) or the LU group (n=17) by the coin flip procedure, underwent acupuncture (leopard spot needling) at PC5 or LU5'', respectively. Two-way mixed-model analysis of variance (ANOVA) with time (pre-intervention vs post-intervention) as the within-subject factor and group (PC vs LU) as the between-subject factor, plus time×group interaction, were used to determine the effects of acupuncture therapy on EE-ROM at pain onset and maximum tolerance during ULNT1.

RESULTS

At baseline there were no differences between groups (p>0.05). After acupuncture, mean EE-ROM increased 3.1° at pain onset (p=0.029, η²_p=0.154) and 5.6° at maximum tolerance (p=0.002, η²_p=0.277) with no differences between groups (p>0.05, η²_p<0.01).

CONCLUSION

Immediately after acupuncture, the mechanosensitivity of the median nerve appears to be reduced as observed by an increase in EE-ROM during the ULNT1. Further studies are needed to confirm these preliminary findings.

TRIAL REGISTRATION NUMBER

NCT02150915; Post-results.

Meditative Movement, Energetic, and Physical Analyses of Three Qigong Exercises: Unification of Eastern and Western Mechanistic Exercise Theory

Qigong is the meditative movement and therapeutic exercise of Eastern medicine. A growing body of evidence is validating its health benefits leading to mechanistic questions of how it works. The purpose of this article is to explore mechanisms of action related to Qigong, with the intent of unifying Eastern and Western exercise theory and to present a model for Qigong exercise analysis. Three exercises from a standardized Qigong form: ‘Plucking the Stars’, ‘Lotus Leaves Rustle in the Wind’, and ‘Pacing Forwards and Backwards’ were selected for meditative, energetic, and physical analyses. Meditative aspects include relaxation response, interoception and exteroception. Energetic aspects include stimulation of meridians through mental intent, acupressure, and self-massage. Physical aspects include flexibility, strength, articular stimulation, neuro-integration, respiratory effect, fascial stretch, visceral massage, balance challenge CranioSacral pump, lymphatic and venous return and glandular stimulation, and physiologic response to relaxation. Knowledge of mechanisms of action for specific Qigong exercises can guide operational definition of Qigong, selection of outcomes assessment in future research, inform prescriptive practice addressing clinical health issues, and advance adoption of Qigong practice within integrative health care. The model of analysis demonstrated in this discussion may assist in these endeavors.